Diagnosis targets in primary care are misleading, unethical, UK experts say

Last month, there was public outcry at the news that GPs in England would be paid £55 for each case of dementia diagnosed.

Now come targets for six other conditions, including diabetes coronary heart disease, asthma and depression, writes Dr Martin Brunet, a GP in Surrey. "But the data on which they are based are flawed, and the approach incentivises potentially harmful overdiagnosis," he argues.

Every practice in England has been told its diagnosis rate for each condition, estimated from practice data and the expected prevalence, he explains. The intention is to exert pressure on general practitioners to increase diagnosis rates, but he believes the principles behind such a policy need to be questioned.

Brunet argues that applying error prone national prevalence data to an individual practice is problematic. Although attempts are made to account for local demographics, practices may be under pressure to "improve" diagnosis rates that are far better than the data would suggest, he warns.

He also questions the ethical implications for individual patients of unnecessary tests and treatments that "could do more harm than good" and divert resources away from people with symptoms.

Targets in healthcare always threaten to undermine trust in the doctor-patient relationship, says Brunet. "For this reason patients need to trust that the doctor will act solely in their best interests, unencumbered by competing interests."

"NHS England needs to hear the clear message from doctors and patients that setting targets for diagnosis is problematic, unscientific, and unethical," he argues. "Instead, it needs to trust doctors and their patients to know when to seek a diagnosis."

Source: BMJ-British Medical Journal

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Doctor who survived Ebola received experimental drug treatment

On 28 September, 2014, a 38-year old doctor, who was in charge of an Ebola virus treatment unit in Lakka, Sierra Leone, developed a fever and diarrhea. He tested positive for the virus on the same day. He was placed on a ventilator and on kidney dialysis, and was given antibiotics together with a 3-day course of an experimental drug called FX06 -- a fibrin-derived peptide that has been shown to reduce vascular leakage and its complications in mice with Dengue hemorrhagic shock. Credit: © nito / Fotolia

On 28 September, 2014, the 38-year old doctor, who was in charge of an Ebola virus treatment unit in Lakka, Sierra Leone, developed a fever and diarrhea. He tested positive for the virus on the same day. The doctor was airlifted to Frankfurt University Hospital on the 5th day of his illness and admitted to a specialized isolation unit.

Within 72 hours of admission he developed signs of vascular leakage and severe multi-organ failure, including the lungs, kidneys, and gastrointestinal tract. He was placed on a ventilator and on kidney dialysis, and was given antibiotics together with a 3-day course of an experimental drug called FX06 -- a fibrin-derived peptide that has been shown to reduce vascular leakage and its complications in mice with Dengue hemorrhagic shock.

A marked improvement in vascular and respiratory function was seen under the combined measures of intensive care and drug treatment. After a 30-day observation period, no Ebola virus genetic material was detected in the patient's blood plasma. The patient was released from hospital and is now with his family.
"Even though the patient was critically ill, we were able to support him long enough for his body to start antibody production and for the virus to be cleared by his body's defenses," explains Dr Wolf.

"In terms of improving treatment for Ebola patients, we have shown how intensive care medicine can successfully be applied under strict isolation conditions," adds senior author Professor Zacharowski, head of the Department of Anaesthetics and Intensive Care Medicine at Frankfurt University Hospital."
The authors conclude by calling for FX06 to be evaluated in clinical trials.

Source: The Lancet

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